Does Managed Care Affect Quality? Appropriateness, Referral Patterns, and Outcomes of Carotid Endarterectomy

Objective—To assess the impact of managed care(MC) on several dimensions of quality of surgical care among Medicare beneficiaries undergoing carotid endarterectomy(CEA). Methods—This was a population-based, observational study of all CEAs(N=9308) in NY. Clinical data were abstracted from medical charts to assess appropriateness and deaths/strokes within 30 days of surgery. Differences in patients, appropriateness, and outcomes were compared using chi square tests and risk-adjusted outcomes compared using regression. Results—Fee-For-Service(FFS, N=8691) and MC(N=897) CEA patients were similar in indications for surgery, perioperative risk, and most comorbidities. There were no differences in inappropriateness between FFS and MC(8.6 % v. 8.4%). MC patients were less likely to have a high volume surgeon(20.1 % v. 13.5%) or hospital(20.5 % v. 13.0%;p<.05). There were no differences in risk-adjusted rates of death/stroke(OR=0.97;95 % CI, 0.69–1.37). Conclusions—Medicare MC plans did not have a positive impact on inappropriateness, referral patterns or outcomes of CEA